Acute kidney failure underreported in COVID-19

CHICAGO — Acute kidney failure, also known as acute kidney injury (AKI), has not been properly reported as a complication of COVID-19, says a new Northwestern Medicine study. Scientists say AKI is a serious complication associated with mortality, but reports have lagged.

“Patients in the hospital with COVID-19 and especially those in the ICU are at risk for AKI, perhaps as many as 25% to 30%,” said Dr. Daniel Batlle, a professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine kidney specialist.

Severe AKI is associated with about 50% mortality rates, Batlle said.

The paper is the first to provide possible mechanisms causing AKI in COVID-19 patients.

The study was published Monday in the Journal of the American Society of Nephrology.

The paper explains that this type of AKI in COVID-19 patients is very complex and involves several factors that are not usually seen in the regular patient with AKI admitted to the ICU. There are unique factors at play like possible invasion of the kidneys by the virus, a tendency to form blood clots and the formation of active mediators of inflammation, among others, that add to the complexity and severity of this type of AKI.         

Batlle and colleagues reviewed two recent studies from China with autopsy information about kidney tissues from patients who died from COVID-19. 

“These new findings should make health care providers increase the focus on the kidneys and obtain proper information about kidney function and structure in COVID-19 patients who develop AKI,” Batlle said. “Then we will have a better understanding of how to intervene.

“A better understanding of the mechanism will foster development of effective therapies beyond the supportive care in the ICU, which is already critically important as many of these patients require dialysis-related therapy,” Batlle said.